Malnutrition is defined as an imbalance of nutrients within the diet and can refer to a deficiency of nutrients as well as an excess. An inadequate nutritional intake and a lack of nutrients or energy (calories) within the diet is more commonly known as ‘undernutrition’. A common misconception is that undernutrition only affects those in developing countries but unfortunately this is still a significant problem for many, even within the UK.
Causes of and risk factors for malnutrition
Malnutrition can affect anyone no matter their age, weight, background, economic status or health condition and many factors can increase the risk of developing this nutritional imbalance.
Medical factors leading to specifically to undernutrition can include:
- Swallowing or chewing difficulties (Dysphagia) – this can make it more challenging to consume large volumes of food at a time, making it more difficult to achieve an adequate nutritional intake.
- Digestive conditions (Crohn’s disease or Ulcerative Colitis) – these can affect the body’s ability to digest and absorb nutrients.
- Cancer – those living with or undergoing treatment for cancer may suffer from weight loss which could be due to increased energy demands, nausea or loss of appetite.
- Mental health conditions – this can include depression and schizophrenia as these can cause low mood and disinterest in food. Eating disorders, such as anorexia, can also lead to undernutrition due to restriction of food intake.
- Dementia – can lead to forgetfulness, making it harder to remember when someone has last eaten and making preparation of meals more difficult.
- Surgery or serious injury – can increase the body’s energy requirements as a result of the body trying to properly recover.
- Medication – some medications can affect appetite and potentially decrease the efficiency of digestion and absorption of nutrients.
Social and physical factors affecting risk of undernutrition can include:
- Low income – this can make it more difficult to access a nutritious and plentiful supply of food.
- Physical disability or impairment – can make it more difficult to shop for, cook and prepare nutritious meals.
- Social isolation – can especially affect the elderly population who may live alone and struggle with the ability to prepare their own meals.
- Poor nutritional knowledge/cooking skills – can commonly affect older people who have become widowed and were previously dependent on someone else to prepare their meals.
Signs of malnutrition
The most common effect of malnutrition, specifically undernutrition, is weight loss. However, it is still possible to be malnourished and be at a healthy weight or overweight. Other effects of undernutrition can include:
- Loss of muscle mass and strength – an inadequate energy and protein intake can lead to muscle weakness, as the body breaks down muscle in order to utilise its protein for energy instead.
- Increased frailty – a deficiency of certain vitamins and minerals such as vitamin D and calcium, especially in the elderly, can increase bone fragility as these nutrients are essential for bone mineralisation.
- Fatigue and tiredness – the body needs energy to function optimally so a poor energy intake can lead to feelings of lethargy.
- Increased susceptibility to infections – our immune systems also require an adequate nutritional supply to effectively fight off infections.
- Poor wound healing – a deficiency of nutrients, particularly protein, can slow the recovery process after surgery or injury, as our bodies need the building blocks and resources to fully recover.
- Difficulty keeping warm – a decrease in fat or muscle mass means the body is less insulated, meaning it is more difficult to maintain a normal body temperature.
- Depression, anxiety, irritability and poor concentration – our brains also need energy and nutrients to function properly and to produce chemical messengers (neurotransmitters), which can help to improve our mood.
Recovering from malnutrition
The best method of recovery from malnutrition will largely be dependent on individual needs and the underlying cause of malnutrition. If malnutrition is severe or due to more complex medical conditions, such as Crohn’s disease, Ulcerative Colitis or Dysphagia, it is always best to speak to a healthcare professional or dietitian. They may be able to provide additional specialist support or medication, helping to manage the root of the problem.
If the cause of malnutrition is linked to poor appetite, difficulties in consuming large volumes of food, or an increase in energy requirements, there are many different approaches which can help to improve nutritional status. For example, consuming smaller but more regular meals throughout the day or choosing more energy dense foods can aid recovery. Incorporating foods rich in calories and protein such as high fat dairy (whole milk, full fat yogurt, cheese, cream), nuts, seeds and eggs can all be ways of helping to meet the body’s needs. Our protein enriched soups and protein rich baked products are another great way of boosting your intake.
If, for whatever reason, eating solid foods is difficult, our IDDSI 7 Easy-to-Chew Birds Eye Soft Meals are a great option in helping to improve nutritional intake. These soft meals provide between approximately 480-590 kcal per portion and contain all the elements of a complete main meal, i.e. protein, carbohydrate and vegetables, with tasty sauces to make the dishes extra palatable. We currently have 8 meals in the range, one of which is vegetarian, and all have been created from pureed food timbales which allow us to present our texture-modified food in the format of the original unpureed food, making the meal as visually appetising as possible. We know this is especially important as we are more likely to eat foods which look appealing to the eye!
Another quick and convenient way of increasing energy, protein, vitamin and mineral intake can be by consuming nutritionally enriched drinks such as our Ensure Max Protein drink which provides 30g of protein per bottle and a wide variety of vitamins and minerals!
In some cases, where an adequate intake of certain nutrients, particularly vitamins and minerals, is not possible from the diet alone, supplementation may also be recommended. It is best to focus on a food-first approach, favouring foods to deliver nutrients over supplements, but in some cases, supplements can be really beneficial in helping to meet nutritional requirements.
To avoid becoming malnourished in the first place, and for those whom this is possible, we should focus on eating a healthy, balanced diet which includes all key food groups. This includes fruits and vegetables, starchy carbohydrates and wholegrains, protein-rich foods, milk and dairy (or fortified alternatives) and small amounts of healthy fats and oils. It is also important to focus on maintaining a healthy weight and monitor if weight significantly fluctuates over time. However, it should also be a priority to identify those who may find it more challenging to shop, cook and prepare their own meals, before malnutrition becomes an issue. Therefore, additional support can be provided for those who are more at risk, including those living with physical disabilities or impairments and older adults. For example, arranging the delivery of groceries, organising a ‘meals on wheels’ service and additional at home care or support from an occupational therapist may all be practical ways to minimise the risk of malnourishment.